Abstract 13150: Risk Factors Associated With Major Adverse Cardiovascular Events Following First-Ever Ischemic Stroke: An Observational Study Using Linked Data From an Australian Stroke Registry

Abstract

Introduction: Survivors of stroke are at increased risk of experiencing subsequent major adverse cardiovascular events (MACE). We aimed to determine the incidence of MACE within two years following first-ever ischemic stroke and identify associated factors. Methods: Patient-level data from the Australian Stroke Clinical Registry (2009-2013) were linked with emergency department and hospital admission data. Patient comorbidities were identified in the emergency and admissions data using published algorithms. Adults with no prior history of acute cardiovascular events were followed for two years post-discharge, or until first occurrence of MACE, whichever occurred earlier. Multivariable competing risks regression, accounting for deaths due to non-cardiovascular causes, was used to determine factors associated with MACE post-stroke. Results: Among 5,994 patients with first-ever ischemic stroke (median age 73 years, 45% female), 17% were admitted for MACE (129/100,000 person-years). MACE incidence was greatest in the first year following stroke (157/100,000 person-years). Compared to participants aged ≥65 years, the median time to first MACE was 37 days earlier for those aged <65 years. As there was a significant interaction (p<0.05) between age and other factors in predicting MACE incidence, subsequent analyses were stratified by age group. Being discharged to inpatient rehabilitation (sub-distribution hazard ratio [SHR]: 0.63; 95% Confidence Interval (CI): 0.44-0.90) was associated with reduced risk of MACE in patients aged <65 years only. Whereas, in those aged ≥65 years, MACE was associated with being female (SHR: 1.04; 95% CI: 1.03-1.05), initial stroke severity (SHR: 1.33; 95% CI: 1.15-1.54), smoking (SHR: 1.41; 95% CI: 1.14-1.71), and atrial fibrillation (SHR: 1.31; 95% CI: 1.14-1.51). Being treated in a large hospital (>300 beds) was associated with a lower risk of MACE in those aged <65 (SHR: 0.68; 95% CI: 0.44-0.90) and ≥65 years (SHR: 0.74; 95% CI: 0.62-0.87). Conclusion: MACE presentations are common within two-years of stroke, with most events occurring in the first year. We have identified factors (e.g., use of rehabilitation among younger patients) to consider when designing interventions to prevent MACE after stroke.